- 著者
- 三幡 輝久 渡辺 千聡 阿部 宗昭 木下 光雄
- 出版者
- 日本肩関節学会
- 雑誌
- 肩関節 (ISSN:09104461)
- 巻号頁・発行日
- vol.31, no.2, pp.433-436, 2007
- 被引用文献数
- 1
The objective of this study was to assess the effect of shoulder horizontal abduction and external rotation on shoulder internal impingement. Eight cadaveric shoulders were tested using a custom shoulder testing system. Rotator cuff insertion points on the greater tuberosity were recorded using Microscribe digitizer at maximum external rotation position. Glenohumeral contact pressure at the maximum external rotation position was measured using a Fuji Prescale Film. Data were compared between the scapular plane (SP), 15 degrees horizontal abduction from scapular plane (15HA), 30 degrees horizontal abduction from scapular plane (30HA, simulated coronal plane), and 45 degrees horizontal abduction from scapular plane (45HA). The comparisons were also made between intact, after 20% stretching anterior capsule (an increased external rotation), and after an anterior capsular placation (a decreased external rotation). Data were analyzed using Tukey's post hoc test (p<0.05). Rotator cuff insertion points at 30HA and 45HA were located significantly anteriorly compared with those at the scapular plane and 15HA (p<0.01). The total contact pressure and total contact area in posterior glenohumeral joint at 30HA and 45HA were significantly greater than those at the scapular plane and 15HA (p<0.001). After stretching, maximum external rotation was increased and rotator cuff insertion points were significantly posteriorly located compared with intact condition at scapular plane (p<0.05). The cuff insertion points at more than 30 degrees of horizontal abduction were anterior to the posterior edge of glenoid, suggesting that excessive horizontal abduction, which is greater than coronal plane, may result in pathologic shoulder internal impingement.
- 著者
- 金 明博 納田 真也 山田 将雄 小坂 理也 阿部 宗昭
- 出版者
- 医学書院
- 雑誌
- 臨床整形外科 (ISSN:05570433)
- 巻号頁・発行日
- vol.35, no.11, pp.1289-1293, 2000-10-25
抄録:Klippel-Feil症候群に伴う頭蓋底陥入に対し、後方除圧とinstrumentによる整復固定術を行い良好な結果を得たので報告する.症例は14歳,男子.外傷などの誘因なく頚部から両肩にかけての疼痛と上肢の筋力低下にて発症した.来院時には上肢の挙上困難とふらつき歩行を呈していた.単純X線では頚椎の癒合椎と高度の頭蓋底陥入を,MRIでは大後頭孔内に陥入した歯突起と環軸椎亜脱臼に伴う環椎後弓による脊髄圧迫像を認めた.Halo-vestを装着し整復を試みたが困難であった.手術は後頭下減圧・環椎後弓切除および後頭骨頚椎間整復固定術(CO-C3)を施行した.術中,instrument (CCD―Cervical)のrodを利用した整復操作を加え,wake-up testにて新たな麻痺が生じていないことを確認した後,骨移植し手術を終了した.術後13カ月の現在,疼痛は消失し上肢の挙上,ランニングとも可能となっている,本法は術前に整復不可能な頭蓋頚椎移行部病変に対し有効な一手術方法と考える.